Our Summary

This study looked at the rates of permanent stoma (an opening created surgically on the body to divert the flow of bodily waste) among patients who had surgery for rectal cancer in the Netherlands in 2016. They found that half of the patients ended up with a permanent stoma, but this varied greatly between different hospitals. The study also looked at whether less invasive surgical techniques resulted in fewer permanent stomas but found no significant difference. The authors suggest the need for better preoperative counselling for patients and a reduction in the variability of outcomes between hospitals.

FAQs

  1. What percentage of patients ended up with a permanent stoma after rectal cancer surgery according to the study?
  2. Did the study find any significant difference in the rate of permanent stomas between less invasive surgical techniques and traditional ones?
  3. What suggestions did the authors make based on the results of the study about rectal cancer surgery outcomes?

Doctor’s Tip

A helpful tip a doctor might give a patient about proctectomy is to discuss the possibility of a permanent stoma with their surgeon before the surgery. It is important for patients to understand the potential outcomes and discuss any concerns or preferences they may have regarding this aspect of the procedure. Additionally, patients should follow their post-operative care instructions closely to ensure proper healing and recovery. Regular follow-up appointments with their healthcare team will also be important for monitoring progress and addressing any issues that may arise.

Suitable For

Patients who are typically recommended proctectomy include those with:

  • Rectal cancer
  • Inflammatory bowel disease (such as ulcerative colitis or Crohn’s disease)
  • Severe rectal prolapse
  • Familial adenomatous polyposis (FAP)
  • Chronic constipation or defecation disorders that have not responded to other treatments

In some cases, proctectomy may be recommended as a last resort treatment for severe and debilitating conditions that have not responded to other therapies.

Timeline

Here is a brief timeline of what a patient may experience before and after a proctectomy:

Before Proctectomy:

  1. Diagnosis of rectal cancer.
  2. Consultation with a colorectal surgeon to discuss treatment options, including the possibility of a proctectomy.
  3. Preoperative testing and preparation for surgery, which may include blood tests, imaging studies, and bowel preparation.
  4. Counseling on the potential need for a permanent stoma and the possible impact on quality of life.

After Proctectomy:

  1. Recovery in the hospital after surgery, which may involve pain management, monitoring for complications, and physical therapy.
  2. Adjustment to life with a temporary stoma, if one was created during surgery.
  3. Follow-up appointments with the surgeon to monitor healing and discuss next steps.
  4. Reversal of the stoma, if possible, in a separate surgery after the initial healing period.
  5. Long-term follow-up care to monitor for recurrence of cancer and manage any long-term effects of the surgery.

It’s important for patients to have a clear understanding of what to expect before and after a proctectomy, including the potential for a permanent stoma, so they can make informed decisions about their treatment and prepare for the physical and emotional challenges ahead.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a proctectomy procedure?
  2. What are the chances of needing a permanent stoma after the surgery?
  3. Are there alternative treatment options to consider before undergoing a proctectomy?
  4. What is the expected recovery time and post-operative care plan?
  5. How experienced is the surgical team in performing proctectomy procedures?
  6. Will I need to make any lifestyle changes or follow a specific diet after the surgery?
  7. Can you provide more information on the variability of outcomes between hospitals for this procedure?
  8. What factors may increase or decrease the likelihood of needing a permanent stoma after a proctectomy?
  9. How will my quality of life be impacted after a proctectomy surgery?
  10. Are there any long-term effects or considerations to be aware of following a proctectomy?

Reference

Authors: Hazen SJA, van Geffen EGM, Sluckin TC, Beets GL, Belgers HJ, Borstlap WAA, Consten ECJ, Dekker JT, Hompes R, Tuynman JB, van Westreenen HL, de Wilt JHW, Tanis PJ, Kusters M; Dutch Snapshot Research Group. Journal: Colorectal Dis. 2024 Jun;26(6):1153-1165. doi: 10.1111/codi.17015. Epub 2024 May 5. PMID: 38706109